Diagnosed + in November 2002 with a virus resistant to PI's (though I don't know to what extent; I guess that I should ask).

I'm treatment-naive and will likely go on meds soon as my CD4 is around 280 and VL is about 5,000. My doctor said my first regimen would be combivir and sustiva.

Does resistance to PI's significantly impact my long-term prognosis? I just learned today that my resistance was to PI's, which are credited to extending so many lives since their development in the '90s. (I knew that I had some resistance previously but was unaware of to what class of drugs.)

Is it worse to be resistant to PI's than other classes of drugs? This news really scared me.

Thank you for your response. This site is an amazing resource!

Response from Dr. Sherer

There is evidence that the response to an ART regimen may be compromised in a patient who acquires resistance mutations, but the answer in your case may hinge on the exact mutations that were found. As you suggest, it will be useful to understand exactly which mutations your virus has, and how these mutations might impact your response to therapy.

The choice of an NNRTI + NRTIs for the first regimen makes sense in these circumstances.

Note that within the PI class, there are many options that provide strong antiviral activity, even in patients with a few baseline PI mutations. For example, lopinavir/r (Kaletra) is not compromised in its effectiveness by the presence of 1-3 PI mutations, and significant reduction in potency does not occur until there are 6-8 PI genotypic mutations.

I suggest that you ask these questions of your doctor, and share this response with him or her, as you consider what your options are for the time when, if at all, you need therapy with a PI.

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